Botulinum toxin for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia

Botulinum toxin (BTX) is the most potent biological toxin used for the treatment of urologic conditions. During the last 3 years, the use of BTX has been extended to the treatment of symptomatic benign prostatic hyperplasia, however, the actual mechanism through which BTX can reduce prostate volume and infravesical resistance is not well understood. This article reviews the main effects of BTX in prostate tissues. A critical analysis of the outcomes of patients who were studied in clinical series that used this toxin to treat lower urinary tract symptoms related to benign prostatic hyperplasia is also presented.     

Levothyroxine Absorption in Morbidly Obese Patients Before and After Roux-En-Y Gastric Bypass (RYGB) Surgery

Background  

Roux-en-Y gastric bypass (RYGB) modifies the anatomical structure of the upper intestine tract, reduces gastric acid secretion, and may impair LT4 absorption. The aim of this study was to evaluate the LT4 absorption in morbidly obese patients before and after RYGB.     

Human cytomegalovirus glycoprotein B genotypes in Brazilian mothers and their congenitally infected infants

A case-control study design was used in order to compare the distribution of human cytomegalovirus (HCMV) glycoprotein B (gB) genotypes in 48 mothers of 49 congenitally infected infants with that observed in 144 mothers of 146 uninfected infants to study genetic variation of HCMV strains and maternal-fetal transmission. Congenital infection with HCMV was characterized by DNA detection and virus isolation from two urine or saliva samples collected prior to the third week of life. Genotyping of HCMV was carried out by a polymerase chain reaction-restriction fragment length polymorphism analysis of the variable region of the gB gene, testing for four genotypes. Genotype frequency was similar among the 28 non-transmitting mothers who were shedding virus (gB1: 25%; gB2: 28.6%; gB3: 42.8%; gB4: 0%), the 37 transmitting mothers (gB1: 21.6%; gB2: 46%; gB3: 27%; gB4: 0%), and the 49 infected infants (gB1: 39%; gB2: 37%; gB3: 24%; gB4: 0%). The same genotype was detected at different body sites (urine, saliva, and blood) of each infected newborn and in the respective mother (breast milk, urine, and saliva). Co-infection with multiple genotypes was observed in the immediate postpartum period in two mothers of infected infants (5.4%) and one non-transmitting mother (3.6%). The gB genotype was not correlated with intrauterine HCMV transmission. The genotype distribution found reflects the overall frequency of wild strains circulating in this geographic region. A single genotype is responsible for congenital HCMV infection. Co-infection with more than one strain, as characterized by gB genotype, was infrequent in women who were presumably immunocompetent.     

Morphological study of <Emphasis Type="Italic">Tetratrichomonas didelphidis</Emphasis> isolated from opossum <Emphasis Type="Italic">Lutreolina crassicaudata</Emphasis> by scanning electron microscopy

Tetratrichomonas didelphidis is a flagellate protozoan found in the intestine of opossums Didelphis marsupialis, Didelphis albiventris, and Lutreolina crassicaudata. The isolate used in this study was from L. crassicaudata and it was cultivated in monoxenic culture with Escherichia coli in Diamond (TYM) medium without maltose and with starch solution (trypticase–yeast extract–starch), pH 7.5 at 28°C. Scanning electron microscopy showed the fine morphological features of the trophozoites: the emergence of the anterior flagella, the structure of the undulating membrane, the axostyle and posterior flagellum. In addition, we described spherical forms that are probably pseudocysts. Our data will contribute to a better understanding of surface structures in T. didelphidis.     

Bioethics and biosafety: the use of biomaterials in dental practice

OBJECTIVE: To analyze the use of biomaterials in surgical procedures carried out by specialist dental surgeons, in light of the Principalist Bioethics Theory and the Individual and Collective Ethics of Responsibility. METHODS: Dental surgeons (n=95), who were registered as specialists at the Regional Dentistry Council of Brasilia as of 2002, completed questionnaires regarding the use of biomaterials in their work. Data relating to sanitary control were collated, based on these dental surgeons' responses and research at relevant organizations. RESULTS: All of the professionals in the survey used biomaterials on a regular basis; 45% believed their use to be risk-free for patients, and 48% did not classify biomaterials as drugs. About 70% of professionals trust the source of the biomaterials even though membranes and bones are the items most commonly bought from individual suppliers. Nonetheless, 96% of interviewees believed that government sanitation agencies should regulate more. More than half of the professionals (51%) pointed to little or no participation by the patient in the process of therapeutic choice. A copy of the informed consent form was provided by 12% of the dental surgeons interviewed produced. CONCLUSIONS: The results showed that the professionals use biomaterials without knowing about related risks and adverse side effects, contrary to the principle of beneficence. Government agencies and professional bodies alike do not show evidence of observing public responsibility ethics. Informed consent is not yet integrated fully into professional practice and the doctor-patient relationship in dentistry remains markedly vertical.     

Can the socioeconomic level influence the characteristics of a group of hypertensive patients?

A total of 440 hypertensive patients participated in the study (57 years old +/-12, 66% women, 51% white, 57% married, 52% with primary school and 44% with income from 1 to 3 minimum salaries) to characterize biosocial, beliefs, attitudes and knowledge variables, absence to consultation and treatment interruption, and to associate the socioeconomic level to the variables studied. An index of accumulated goods, from the possession of household appliances converted in minimum salaries/mo., was elaborated in order to evaluate the economic status. The hypertensive people who disagreed with "there is nothing you can do to prevent high blood pressure" presented significantly higher levels of accumulated goods; those who affirmed never getting late to their consultations presented lower levels of accumulated goods; in the subjective well-being evaluation, sadness was associated to a lower accumulated goods index (p<0,05). Results showed that low economic status was associated with factors that can influence the attitude and adherence to anti-hypertensive treatment.     

Translabial ultrasonography in the assessment of urethral diameter and intrinsic urethral sphincter deficiency.

OBJECTIVE: The purpose of this study was to determine the role of translabial ultrasonography in the investigation of intrinsic urethral sphincter deficiency (ISD), assessing bladder neck hypermobility and urethral diameter in continent and incontinent patients. METHODS: A case-control study evaluated 94 women with the diagnosis of urinary incontinence and 96 continent women. Both groups underwent translabial ultrasonography to assess bladder neck hypermobility by means of the x-y coordinate system and urethral diameter. The study was performed at Hospital de Clínicas de Porto Alegre. RESULTS: Women with urinary stress incontinence showed significantly greater bladder neck descent than continent women and women with urge and mixed incontinence (P = .05). Women with ISD showed significantly larger urethral diameters than control subjects and incontinent women without ISD (P = .05). Of women with urinary incontinence, 78.7% had descent of greater than 10 mm, and 91.7% of the women with ISD had urethral diameters of greater than 6 mm. A urethral diameter of greater than 6 mm showed sensitivity of 91.7% and specificity of 75.6% for ISD. CONCLUSIONS: Translabial ultra-sonography has an important role in the assessment of women with urinary stress incontinence and intrinsic urethral sphincter deficiency.     

Echographic evaluation of the thyroid gland and urinary iodine concentration in school children from various regions of the State of São Paulo, Brazil

We have examined, by ultrasonographic studies, the thyroid gland of 844 schoolchildren, aged between 6 and 14 years old (423 girls, 421 boys). There was a progressive increase of the thyroid volume with aging with a positive and significant correlation with the body surface area. The presence of enlarged thyroid gland was rarely seen, being present in only 1.6% of the studied cohort. A few thyroid gland abnormalities were noticed such as hemiagenesia (4 children), nodules and cysts and hypoechogenicity (total: 1.4% of all subjects examined). It was clearly demonstrated that the urinary excretion of iodine was elevated being above 300 microg Iodine/L in 53% of the schoolchildren examined. Assays for the iodine concentration in the domestic salt samples revealed values between 28.1 and 63.3 mgI/kg of salt. We concluded that the schoolchildren population of the State of S?o Paulo may be under an excessive daily ingestion of iodine. This may induce, if extrapolated to the general population, subclinical hyperthyroidism in the elderly and possibly an increment in the prevalence of chronic autoimmune thyroiditis.